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Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
March, 2005, Vol. 05, Issue 03
The Inside-Out Paradigm: Equalizing the Pressure
By Dale G. Alexander, LMT, MA, PhD
Read Dale's previous article, "Healing From the Core: A New Paradigm," Parts 1 & 2, in the Sept. and Oct. 2004 issues of Massage Today at: www.massagetoday.com/archives/2004/09/20.html and www.massagetoday.com/archives/2004/10/04.html.
This article will explore a few of the many elements of anatomy and physiology that are fundamental to the proposed paradigm of working from the "inside-out." My first article, "Healing From the Core: A New Paradigm," postulated three core elements that assist the healing process:
The centerpiece of this paradigm is simply to work with how the body maintains itself physiologically and proprioceptively at the same time. Most biomechanical models infer that the source of constricted vascular circulation is the result of the extrinsic musculature's battle to maintain body posture within and against the field of gravity. This is partially accurate. However, it is postulated that contraction of the visceral suspension is a more primary source of vascular congestion and that much of what throws the proprioceptive balance off in the first place is the result of how the body discharges visceral tension into the intrinsic musculature, which then affects the kinetic chain of the joints, thus placing a demand on the extrinsic musculature to contract in order to protect individual joints and the overall balance of an individual. It is a complex both/and scenario. But with further exploration, it will become clearer.
An overlooked aspect of anatomy in our work as massage therapists is that the human body has three great cavities designed to assist the movement of fluids and support the upright carriage of our human structure based on the pressure differences between them. These are the abdominal-pelvic; the thorax; and the cranium.
According to Dr. Jean-Pierre Barral, the developer of Visceral Manipulation, the pressure of the thoracic cavity in a healthy system is negative in relation to the more positive pressures within abdominal-pelvic and cranial cavities. This negative pressure also acts like a helium balloon to support our posture in the field of gravity.1
This difference in the pressure relationships between the cavities is how the efficiency of the low pressure venous and lymphatic systems is normally maintained in their job of returning their fluids back to the heart and lungs to be re-nourished and recycled. Let us remember that fluid moves from an area of greater concentration to an area of lesser concentration naturally. Thus, as one assists the body to re-establish the negative pressure within the thoracic cavity, it allows for an equalization of pressures between the cavities.
How does one tell if the thoracic pressure has become more positive with a client on your massage table? Simple palpation and soft compression of the thorax will readily indicate to you the degree of positive pressure. The less flexible the thorax, the more positive the pressure and, by inference, the slower the flow of venous and lymph return.
Within the body's three great cavities are four visceral sacs:
Each of these sacs is related to physiological waves of expansion and contraction, which are crucial to normal fluid circulation. Their rhythms support the healing process and maintain normal homeostatic regulation:
All of these rhythms are influenced by the pressure within the cavities and sacs, and by the pressure of the tubes within the sacs and by the pressure within those tubes, which pass between the sacs and cavities. Obviously, this adds emphasis to the tone and length of the esophagus, as it is the connecting tube between the cranial vault, thoracic cavity, and abdominal/pelvic cavity. It offers a release valve to the pressures, which often build up within the alimentary canal in addition to the anus at the lower end.
These rhythms are homeostatically regulated between the two divisions of the Autonomic Nervous System; the parasympathetic outflow of the vagus and pelvic splanchnic nerves and the sympathetic nerves exiting from T1-L2 of the spinal cord. It is the flexibility between these two divisions, which regulates who gets the blood thereby the oxygen and nutrients needed to support the healing process.2
How does this pressure in the tubes, sacs and cavities build in the first place? By soft-tissue contraction of the sacs and tubes of the viscera, which lessens the space for the liquids and gases within them. This internal contraction pressurizes the contents. When this pressure is unable to equalize, it builds. The building of pressure creates more soft-tissue tension. The cycle repeats again and again. The body attempts to distribute these tensions both directly and reflexively.
The theorized direct method was described in the first article: visceral tensions build, then spill over into the intrinsic musculature, which then pull on the osseous system until a dysfunction of motion is created affecting joint range of motion. This both releases some of the internal pressure, but also stimulates the extrinsic musculature to contract to protect the joints from further displacement. Inevitably, one's posture and sense of balance is also affected.
The reflexive method involves the distribution of tensions and strain through more generalized viscero-somatic reflex arcs. These relate to both segmental levels of the spinal cord and regional areas that have come to be recognized by surgeons as indicators of acute organ pathology.
What I've come to realize is that the body is organized to use the joints of the axial and appendicular skeleton in a very similar fashion to an electrical circuit-breaker system in a more modern home. Organ correlation to segmental levels of the spinal cord are referred to as spinal correspondences and are maps to the work of chiropractors and the osteopaths who directly manipulate the joints.
Regional reflex areas, such as the right shoulder/scapula area associated with liver/gall bladder congestion, stasis and disease, are referenced in some medical textbooks but are more commonly found, and their relevance more usefully described, in surgical references.3
The paradigm of working from the "inside-out" suggests that as massage therapists, we need to learn how to equalize the pressures within the tubes, sacs, and cavities of the body as a first step to assisting our clients. Additionally, knowledge of the aforementioned spinal correspondences and regional reflex areas can be invaluable for making timely and appropriate referral of our clients to medical care from the onset of working with them, or when they are not making progress.
Competent massage therapy of any orientation will assist stress-induced states of congestion to dissipate with a lessening or disappearance of the initial symptoms. When this doesn't occur, it is our ethical responsibility to encourage medical evaluation. A "well-baby" visit to a physician can be invaluable to the mental health of a client who fears something is amiss.
Stress-related problems follow the progression offered in the first article: adaptation, compensation/substitution, injury/illness, degeneration/disease. Trauma simply speeds one along the continuum. It is common for a client to have all the relevant medical tests and return for additional work as what is brewing within them has not reached the tipping point of recognizable pathology.
Now to lightly kiss the question of why stress affects some people more than others and some in particular areas, while others in totally different ways. As humans, we assign meaning to our experiences in life. We develop a complex array of positive and negative anticipations to events. We live in the models of our mind more than in the present time, experience of life unfolding moment by moment. This is the arena of consciousness and is the most powerful tool for change and evolution for ourselves and our species.
My experience professionally and personally reflects an additional existential theorem, as well: Our bodies are our vehicles for the development of consciousness, the growth of our soul and spirit, and the integration of our personality and spirit. Our bodies are where the action is happening. It embodies our confusions and terrors, our willingness and readiness for change. The body really does reflect a Map of Consciousness.4
Touch bridges time and space, and is the vehicle for re-modeling our inner landscape of attitudes, possibilities and behavior.
For those new to the profession, much of this may have been more than a mouthful, or simply tedious reading, yet it is what we are challenged to hold in our work, and there is more. It has taken years of concentrated experience and study across many disciplines to tease apart the foundational elements of anatomy and physiology to make sense of how the gestalt of the body works in relation to its dance with the psyche.
In truth, this paradigm of working from the inside-out is only the springboard for many connections that are to come in future years.
These basics, and others to follow, have consistently shown themselves to be fundamental to working with clients, especially those with chronic problems. Our real challenge is to expand our perception broadly to include additional dimensions and to nurture our quality of touch to assist our clients to integrate themselves across the many levels of human consciousness.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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